BACKGROUND: Surgical reconstructions for venous occlusive disease are rarely performed. Consequently, reliable data on long-term patency, clinical outcome, hemodynamic evaluation and risk factors for graft occlusion are poor. The present study was aimed at assessing long-term results of venovenous bypass operations in postthrombotic syndrome (PTS). METHODS: We analyzed long-term outcomes of crossover vein bypass procedures in 68 patients with unilateral postthrombotic iliac vein obstructions at periods from two to 28 years and 12 patients who underwent saphenopopliteal bypasses for femoral vein obstructions. RESULTS: It was validated that the decisive factor of the success of the crossover bypass procedure was a sufficient diameter of venous graft, i.e., not less than 7–8 mm. The advantage of dilated great saphenous vein of affected extremity is shown in this study. It has been determined that in 70.6% of the patients, crossover grafts have a propensity to dilate, furnishing the requisite venous blood outflow from an affected extremity. Venous hemodynamic studies of the affected extremity with occlusion of the external pressed graft revealed that crossover bypass assumes the primary role in the maintenance of venous return. In 15 years, cumulative patency of crossover grafts was 77%. There was cumulative clinical success in 71% of the patients. The patency rate of saphenopopliteal grafting within the period up to 12 years was 91.7%. Long-term outcomes of the procedures proved durable functioning of the grafts and improvement of regional venous hemodynamics. There was significant improvement of reconstructive operations with the usage of distal arteriovenous fistulas. CONCLUSION: Long-term results demonstrated a high efficacy of venovenous bypass operations in PTS.

One of the most widespread reconstructive operations employed for unilateral post-thrombotic iliac vein occlusion is the cross-femoral saphenous vein bypass, also known as the Palma procedure (1). In recent years, endovascular stenting operations for iliac vein obstructions have been widely utilized in clinical practice due to their minimally invasive techniques and reliable long-term outcomes. Today, the crossover bypass is perceived as an alternative reconstruction, if endovascular options fail or they are not possible (2,3). In a few large series have been reported, overall patency of saphenous vein Palma grafts including about 400 operations ranged between 70% and 83% at three-five years (4). Some authors have reported good results utilizing externally supported polytetrafluoroethylene (PTFE) prosthetic grafts, coupled with proximal arteriovenous fistula (AVF) formation (5). In order to improve the results of crossover bypasses, Gloviczki and Cho were the first to perform an endophlebectomy from the femoral vein of the affected extremity (6).

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